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<div id="_header" style="outline: none; min-height: 0.65cm; padding-left: 2.49cm; padding-right: 0.99cm; position: relative;" contenteditable="false" class="">
	<p style=" font-family: 宋体; font-size: 12pt;">   
		<label style=" font-family: 宋体; font-size: 18pt; font-weight: bold;">住院病人营养治疗专业评估表</label>
	</p><p style=" font-family: 宋体; font-size: 12pt;">
		<label style=" font-family: Times New Roman; font-size: 10.5pt; font-weight: bold;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Nutrition&nbsp;Therapy&nbsp;Assessment&nbsp;Form&nbsp;of&nbsp;Inpatient&nbsp;Over&nbsp;the&nbsp;Age&nbsp;of&nbsp;14</label>
	</p><p style=" font-family: 宋体; font-size: 12pt;"></p><hr>
		<label style=" font-family: 宋体; font-size: 12pt;">姓名：</label>
		<a tabindex="0" id="patientName" name="patientName" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="姓名">姓名</a>
		<label style=" font-family: 宋体; font-size: 12pt;">     性别：</label>
		<a tabindex="0" id="field4" name="EMRSexType" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="性别">性别</a>
		<label style=" font-family: 宋体; font-size: 12pt;">    年龄: </label>
		<a tabindex="0" id="field15" name="complex_NianLin" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="复杂年龄">复杂年龄</a>
		<label style=" font-family: 宋体; font-size: 12pt;">    出生日期：</label><a tabindex="0" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" id="field3" name="EMRDateBirth" type="DateTime" format="yyyy年MM月dd日" value="" placeholder="出生日期">出生日期</a>
	<p style="">
		<label style=" font-family: 宋体; font-size: 12pt;">科别：</label>
		<a tabindex="0" id="field13" name="T2HcDeptName" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="住  院  科  室  名  称">住  院  科  室  名  称</a>
		<label style=" font-family: 宋体; font-size: 12pt;">    床号：</label>
		<a tabindex="0" id="field12" name="PINBedNbrFirst" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="病床号">病床号</a>
		<label style=" font-family: 宋体; font-size: 12pt;">    健康档案号：</label>
		<a tabindex="0" id="field5" name="EMRId" class="blank input" style=" font-family: 宋体; font-size: 12pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="健康档案号">健康档案号</a>
</p></div>

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	<p style=" font-family: 宋体; font-size: 11pt;">
		<label style=" font-family: 宋体; font-size: 11pt;">入院日期：</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label><a tabindex="0" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" id="field8" name="PinDateSysTime" type="DateTime" format="yyyy年MM月dd日" value="" placeholder="yyyy年MM月dd日">yyyy年MM月dd日</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
	</p><p style=" font-family: 宋体; font-size: 11pt;">
		<label style=" font-family: 宋体; font-size: 11pt;">临床主要诊断:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">                                                                             </label>
	</p><p style=" font-family: 宋体; font-size: 11pt;">
		<label style=" font-family: 宋体; font-size: 11pt; font-weight: bold;">营养评估：注明：</label>
		<label style=" font-family: 宋体; font-size: 11pt;">（记录可在</label>
		<input type="checkbox" id="checkbox4">
		<label for="checkbox4" style=" font-family: 宋体; font-size: 11pt;">打√，无则写无，未使用就写未使用或不适用）</label>
	</p><p style=" font-family: 宋体; font-size: 11pt;">
		<label style=" font-family: 宋体; font-size: 11pt; font-weight: bold;">1、一般状况</label>
	</p><p style=" font-family: 宋体; font-size: 11pt;">
		<label style=" font-family: 宋体; font-size: 11pt;">    身高:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field9" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="身高">身高</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<label style=" font-family: 宋体; font-size: 11pt;">cm  实际体重:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field10" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="体重">体重</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<label style=" font-family: 宋体; font-size: 11pt;">kg  BMI:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field11" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<label style=" font-family: 宋体; font-size: 11pt;">kg/m</label>
		<label style=" font-family: 宋体; font-size: 11pt;">2</label>
		<label style=" font-family: 宋体; font-size: 11pt;">  标准体重:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field14" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<label style=" font-family: 宋体; font-size: 11pt;">kg</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11pt;">    通常体重:</label>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field16" class="blank input" style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11pt; text-decoration: underline;">   </label>kg(指的是最近3-6个月的体重)       干体重:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field17" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>kg
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    意识:
		<input type="checkbox" id="chk2">清醒    
		<input type="checkbox" id="chk3">意识障碍                   水肿：
		<input type="checkbox" id="chk4">无   
		<input type="checkbox" id="chk5">有
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    咀嚼和吞咽困难：
		<input type="checkbox" id="chk6">无  
		<input type="checkbox" id="chk7">有  
		<input type="checkbox" id="chk8">管饲          食欲：
		<input type="checkbox" id="chk9">佳 
		<input type="checkbox" id="chk10">中 
		<input type="checkbox" id="chk11">差 
		<input type="checkbox" id="chk12">不适用
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    学习动机：
		<input type="checkbox" id="chk13">强烈 
		<input type="checkbox" id="chk14">一般 
		<input type="checkbox" id="chk15">弱 
		<input type="checkbox" id="chk16">不适用       学习障碍：
		<input type="checkbox" id="chk17">不适用 
		<input type="checkbox" id="chk18">无 
		<input type="checkbox" id="chk19">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">       </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    劳动强度：
		<input type="checkbox" id="chk20">卧床 
		<input type="checkbox" id="chk21">轻 
		<input type="checkbox" id="chk22">中 
		<input type="checkbox" id="chk23">重             精神：
		<input type="checkbox" id="chk24">佳 
		<input type="checkbox" id="chk25">一般 
		<input type="checkbox" id="chk26">差 
		<input type="checkbox" id="chk27">不适用
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    运动：
		<input type="checkbox" id="chk28">无 
		<input type="checkbox" id="chk29">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                  </label>            频率：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">         </label>次/周
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    使用（营养）相关补充品：
		<input type="checkbox" id="chk30">不适用   
		<input type="checkbox" id="chk31">无   
		<input type="checkbox" id="chk32">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                    </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">2、一天膳食摄取量与肠内营养制剂大概回顾</label>（日常饮食及大致数量举例）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    早餐：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    早点：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    午餐：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    午点：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    晚餐：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    晚点：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                              </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    肠内营养制剂：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                      </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    饮料：          
		<input type="checkbox" id="chk33">无  
		<input type="checkbox" id="chk34">有：
		<input type="checkbox" id="chk35">咖啡 
		<input type="checkbox" id="chk36">果汁 
		<input type="checkbox" id="chk37">酒 
		<input type="checkbox" id="chk38">其他
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                           </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    点心、零食：    
		<input type="checkbox" id="chk39">无  
		<input type="checkbox" id="chk40">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">              </label>    嗜好食物：
		<input type="checkbox" id="chk41">无 
		<input type="checkbox" id="chk42">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                  </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    忌食或过敏食物: 
		<input type="checkbox" id="chk43">无  
		<input type="checkbox" id="chk44">有
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                         </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    目前胃肠道情况：
		<input type="checkbox" id="chk45">正常 
		<input type="checkbox" id="chk46">恶心呕吐 
		<input type="checkbox" id="chk47">腹泻 
		<input type="checkbox" id="chk48">便秘 
		<input type="checkbox" id="chk49">胃积存量
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">      </label>ml 
		<input type="checkbox" id="chk50">其他
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">       </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    
		<label style=" font-family: Times New Roman; font-size: 10.5pt;">目前使用</label>
		<label style=" font-family: Times New Roman; font-size: 10.5pt; font-weight: bold; text-decoration: underline;">药物</label>
		<label style=" font-family: Times New Roman; font-size: 10.5pt;">：</label>  
		<input type="checkbox" id="chk51">抗生素类：
		<input type="checkbox" id="chk52">头孢类  
		<input type="checkbox" id="chk53">青霉素类  
		<input type="checkbox" id="chk54">
		<label for="chk54" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                             </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">                    
		<input type="checkbox" id="chk55">其他药物：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                       </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">3、实验室检查资料</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    白蛋白：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field18" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g/L    球蛋白：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field19" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g/L     总蛋白：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field20" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g/L  
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    血脂肪酶:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field21" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>u/L   血淀粉酶:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field22" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>u/L    Cr.:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field23" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>umol/L
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    TG:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field24" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L      TCHO:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field25" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L     Ca:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field26" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    ALT:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field27" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>U/L   AST:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field28" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>U/L   Na:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field29" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L   K:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field30" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    淋巴细胞百分比:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field31" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>%   血红蛋白:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field32" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g/L   糖化血红蛋白:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field33" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>%
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    WBC:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field34" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>10
		<label style=" font-family: 宋体; font-size: 11.25pt;">9</label>/L          尿酸:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field35" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>umol/L     尿酮体:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">         </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    空腹血糖:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field36" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L    餐后血糖:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field37" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>mmol/L
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    其它:
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                            </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">4、静脉营养应用状况：</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                                 </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  4.1目前以上一天静脉营养热能评估为：
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">    总热能：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field38" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>Kcal       蛋白质：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field39" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">5、目前每日实际热量摄取总量为：</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  5.1热能
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field40" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>Kcal          蛋白质：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field41" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  5.2目前饮食医嘱：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                            </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">6、总体营养状态评价：</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  6.1营养需求量
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field42" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>Kcal    蛋白质：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>
		<a tabindex="0" id="field43" class="blank input" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;" contenteditable="true" type="Text" value="" placeholder="数值">数值</a>
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">   </label>g
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  6.2营养问题
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  奶类摄取量：    
		<input type="checkbox" id="chk56">正常  
		<input type="checkbox" id="chk57">过多  
		<input type="checkbox" id="chk58">不足     糖类摄取量：
		<input type="checkbox" id="chk59">正常  
		<input type="checkbox" id="chk59635921599466888197">过多  
		<input type="checkbox" id="chk59635921599466888198">不足 
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  蛋白质摄取量：  
		<input type="checkbox" id="chk62">正常  
		<input type="checkbox" id="chk62635921599591376416">过多  
		<input type="checkbox" id="chk62635921599591376417">不足     水果摄取量：
		<input type="checkbox" id="chk65">正常  
		<input type="checkbox" id="chk65635921599726472653">过多  
		<input type="checkbox" id="chk65635921599726472654">不足 
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  膳食纤维摄取量：
		<input type="checkbox" id="chk68">正常  
		<input type="checkbox" id="chk68635921599893860947">过多  
		<input type="checkbox" id="chk68635921599893860948">不足  
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  油脂摄取量：    
		<input type="checkbox" id="chk71">正常  
		<input type="checkbox" id="chk71635921600017569164">过多  
		<input type="checkbox" id="chk71635921600017569165">不足  
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  
		<input type="checkbox" id="chk74">其他
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                               </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<label style=" font-family: 宋体; font-size: 11.25pt; font-weight: bold;">7、饮食计划：</label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk75">
		<label for="chk75" style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                </label>饮食原则指导                        （
		<input type="checkbox" id="chk82">手册 
		<input type="checkbox" id="chk83">单张 
		<input type="checkbox" id="chk84">口头 
		<input type="checkbox" id="chk85">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">   
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">             </label>kcal/日；蛋白质：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">        </label>g/日
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk76">低胆固醇饮食指导                                    （
		<input type="checkbox" id="chk86">手册 
		<input type="checkbox" id="chk86635929554916882026">单张 
		<input type="checkbox" id="chk86635929554916882027">口头 
		<input type="checkbox" id="chk86635929554916882028">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk77">低甘油三酯饮食指导                                  （
		<input type="checkbox" id="chk90">手册 
		<input type="checkbox" id="chk90635929554942243477">单张 
		<input type="checkbox" id="chk90635929554942243478">口头 
		<input type="checkbox" id="chk90635929554942243479">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk78">低血糖的饮食照顾                                    （
		<input type="checkbox" id="chk94">手册 
		<input type="checkbox" id="chk94635929554960824540">单张 
		<input type="checkbox" id="chk94635929554960824541">口头 
		<input type="checkbox" id="chk94635929554960824542">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk79">低盐饮食指导原则                                    （
		<input type="checkbox" id="chk98">手册 
		<input type="checkbox" id="chk98635929555115983414">单张 
		<input type="checkbox" id="chk98635929555115983415">口头 
		<input type="checkbox" id="chk98635929555115983416">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk80">食物代换技巧                                        （
		<input type="checkbox" id="chk102">手册 
		<input type="checkbox" id="chk102635929555139424755">单张 
		<input type="checkbox" id="chk102635929555139424756">口头 
		<input type="checkbox" id="chk102635929555139424757">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">
		<input type="checkbox" id="chk81">其他
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                </label>（
		<input type="checkbox" id="chk106">手册 
		<input type="checkbox" id="chk106635929555162326065">单张 
		<input type="checkbox" id="chk106635929555162326066">口头 
		<input type="checkbox" id="chk106635929555162326067">示范）
	</p><p style=" font-family: 宋体; font-size: 11.25pt;">  
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                                                                                      </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt; text-align: Right;">营养师签名：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                    </label>
	</p><p style=" font-family: 宋体; font-size: 11.25pt; text-align: Right;">评估日期：
		<label style=" font-family: 宋体; font-size: 11.25pt; text-decoration: underline;">                      </label>
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		<label style=" font-family: Times New Roman; font-size: 10.5pt;">H01-06-YW-164&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;2015-10-A4</label>
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